Personal story of a training load error

Neil - Doctor of PhysiotherapyBlog, Evidence0 Comments

Some time ago I developed a really uncomfortable pain in my right hip. It was always at the back rather than the front and felt how many people describe sciatica. It wasn’t sciatica but the intense discomfort was in the buttock and hamstrings and would radiate as far as the foot. It was most aggravated by driving and I occasionally had to stop and get out of the car for a walk. I also remember it being uncomfortable walking, particularly at the point when the heel hit the floor.

At the time I wasn’t sure what it was and don’t recall any particular reason for it starting. It seemed to persist for weeks. I didn’t do anything in particular to try and resolve it because I didn’t know what it was. Like most things though it eventually disappeared with time and I quickly forgot about all about it…..until last week.

Exactly one week ago it came back again and I’m pretty sure I now know what it is.

There’s been a lot of talk recently about load management, in particular the work of Dr Tim Gabbett (PhD) which has popped up on various social media and podcasts. On Monday last week I decided to start a training diary after hearing that Adam Meakins considers the lack of one a red flag for active individuals – how do you know if it’s a training load / overuse error if you don’t maintain a diary of training load!?

Anyway, I lifted, swung, pressed, squatted and snatched 4320kg of kettlebell in addition to six different body weight exercises. There were seven loaded exercises and all of them using a 24kg bell and didn’t consider it a big session. None of the loaded e excuses had been pushing the physiological envelope. The one exercise I do recall being especially challenging at the time though was a high hip bridge with knee flexion with my feet in the straps of a TRX. There are no knee-biased hamstring exercises using kettlebells and it’s not been a part of my training program for many years since the gym-days of lying hamstring curls. Aside from sitting, especially in the car, the one position which reproduced the pain was an end-range single leg deadlift position.

I have all the signs of a proximal hamstring tendinopathy. On Sat it hadn’t bothered me all day. Within minutes of getting in the car to go home though the pain came on and within 10 minutes I was ready to pull over because it had quickly becoming unbearable. Remembering the recommendations about reducing the compressive load on the attachment and reducing the degree of hip flexion, I pumped the car seat right up. At its lowest point where it had been the seat is angled backwards which increases hip flexion even further. As the seat lifted it also tips forward. I also angled the seat back further backwards to open the hips even further.

Results: an unbearable discomfort in the back of the thigh, knee and lower leg almost completely disappeared immediately.

Managing the pain of tendinopathy is easy and has worked a treat, although I’ve barely had to use them – isometrics knee flexion: 3x 30s up to 5x 45s. ‘Treat the donut not the hole’ suggests a program of graded loading (heavy, slow, resistance) and avoiding things which may aggravate it – hamstring stretches, running, plyometrics etc. I don’t do much if any of those things (no running at all) so it’ll be interesting to see how long it takes for the discomfort to disappear for good.

Manual therapy not indicated.

Ps. I could be wrong… 😉

http://bjsm.bmj.com/content/early/2016/09/01/bjsports-2016-096040.short?g=w_bjsm_ahead_tab

https://www.clinicaledge.co/podcast/physio-edge-podcast/physio-edge-046-proximal-hamstring-tendinopathy-with-tom-goom

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